Provider Demographics
NPI:1780090183
Name:WANDA BURNLEY
Entity type:Organization
Organization Name:WANDA BURNLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURNLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-835-8379
Mailing Address - Street 1:1439 SARA AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305
Mailing Address - Country:US
Mailing Address - Phone:330-835-8379
Mailing Address - Fax:
Practice Address - Street 1:1439 SARA AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305
Practice Address - Country:US
Practice Address - Phone:330-835-8379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health